New To Your Site and Need Help

[Jamie & Clover]

Hello, my name is Jamie and my diabetic cat is Clover, 11 yr old male, silver tabby.
I’m so glad I found you because I’m having a lot of trouble getting his diabetes under control and the vet has been mostly no help at all and recommended I take him to a specialist for more tests. I’m meeting with a new vet tomorrow, not a specialist, but at this point I’d like to try the Tight Regulation Protocol and feel I just need a vet to write me an rx and do tests when he needs them. Hopefully the new vet will be on board and possibly offer more than the last one.

Here’s a bit of history and what I’ve been doing for the past 7 weeks:
He was initially dx with diabetes Sept, 2020. At that time he was staying with my parents out of state. My dad was used to giving insulin shots to their old cat, and not knowing what I know now, I assumed all would be fine with the vet helping him.
I flew there right after his dx and got Clover started on insulin, researched the right food, and took him off the dry food. He’d been having grain-free, wet, decent quality, all his life along with grain-free dry. But not low carb. The vet did not recommend regular glucose monitoring other than 1x weekly when my dad would take him in and the vet would do a glucose test. At some point my dad declared that he’d gone into remission, but I’m doubting that now. After that, my parents went back to feeding him dry and were not careful about carb content despite my telling him that he could become diabetic again. He gained a lot of weight and weighed 19lbs when I was finally able to bring him home last Sept., (long story to say), it’s possible he’s been diabetic for awhile.
I immediately took him off dry food and he easily lost 3 lbs and was looking and definitely feeling better. He has stalled at 16lbs and needs to lose another lb or
lb 1/2.
Mid December he got sick with an unknown infection that antibiotics cleared up and that’s when they found his glucose was high in the 400’s.
She ordered a FreeStyle Libre monitor and sensor so I took his levels daily for 2 weeks. Twice I did an 18 hr curve.
He’s on 3u of Glargine 2x daily.
The vet wanted me to feed him only twice a day, but that is next to impossible with him. She agreed to try feeding him as I usually do. His levels rarely went into normal range, it generally takes 4-6 hrs for them to go down (not normal range) after the morning injection and they go up several hrs before time for the next injection.
I’m now back to using the regular glucose monitor for the last few days and have gotten a couple normal readings, a couple low readings and high readings, but generally better. I’m not sure if this is a coincidence, but now I’m feeling unsure about the accuracy of one of the monitors. Any idea which is most accurate? I’m using a human monitor.

I must admit that I also have been feeding him Ziwi Peak, which I just found out yesterday is very high carb and has chickpeas in it. So that may explain some of the problem, but the other foods are all 3%-0 carbs. So he wasn’t getting the high carb food at every meal, but once or possibly twice a day. Yesterday I downloaded the carb counter app and checked all of his food so that is clear and solved.
I am an acupuncturist and used to caretaking and problem solving difficult cases and I’m pretty good at hanging in there with hard situations, but I must say, this has been really hard. I’d really appreciate some help and support.

Any advice/info on the difference/accuracy between the libre monitor (glued to his skin) and a regular glucose monitor.

Any specific questions for the new vet tomorrow.

How to transition him to the Tight Regulation Protocol vs continuing with Glargine. Can you do TRP with Glargine?
Or does TRP imply the ProZinc?

Can I continue to feed him throughout the day and get results?

Any idea if there’s still a chance he could go into remission?

And anything else I haven’t asked but need to know. I’m the kind of person who likes to learn and educate myself about what I’m doing so I can really understand it, rather than just following advice/protocol.

Thanks for taking the time to read my long thread. I just wanted to give a clear picture. I can post his glucose readings.
They generally go down to 200’s and up to 400’s, but as I’ve said, they’ve been better after using the regular monitor. I’ve read something about a spreadsheet, but I’m a Luddite so hopefully I can figure out whatever is needed.

Thanks so much!
What a much needed service you are generously providing.
Jamie & Clover

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

I hope the new vet is helpful. If not, there are many members here who have vets who are wonderful for everything except managing diabetes. We can help with the diabetes management. The research on glargine suggests that cats that are newly diagnosed (i.e, within the first year from diagnosis) have the best chance at remission.

The Tight Regulation Protocol was developed by Roomp & Rand in 2009 specifically for use with Lantus and Levemir. In other words, the dosing method was developed for use with glargine so you're good on that count. We are very familiar with TR. The version of TR that has been popularized for Prozinc has been problematic. Elizabeth Hodgkins, the vet who was a major proponent, did not advocate using higher carb food to raise low numbers. Needless to say, there have been cats who died from hypoglycemia from following her instructions.

There have been discussions here about the Libre. Some people have had good success with it. Others, not so much. Some members have reported that the numbers were off. That said, we have much more experience with glucometers than the continuous glucose monitors like the Libre.

It is fine to feed your cat multiple times a day. It can actually be helpful with keeping your cat in good numbers and for not putting undue stress on a cat's pancreas. It may be helpful to limit food after the lowest point in the cycle (i.e, the nadir) since the insulin begins to wear off. However, you want to not feed within 2 hours of shot time. You don't want your pre-shot test number to be influenced by food. I'm curious where you found the information on ZiwiPeak. The regular flavors (e.g., beef, venison, lamb, lamb & rabbit) are low in carbs. Beef is the higher at 10%. All of the other flavors are between 3 - 6% carb which is low carb food. You may want to take a look at this chart that lists the carbs on most of the available canned cat food.

If you're planning on posting your test data, we have a spreadsheet that will be very helpful. This is a link on helping us to help you. It will provide instructions for setting up a spreadsheet, what information to include in. your signature and other information that's useful in getting started.

You asked about information when meeting with a new vet. This is a link to a post on information for screening a new vet. If you haven't noticed, we probably have a post or several on pretty much anything you may need to know!

Please let us know how we can help. The members here are very generous with their time and knowledge.

 

[FrostD]

Welcome!

I see Bron out and about, she and I always tend to cross post so I'll wait and she if she's working on a long post for you before inundating you with links lol

We really will need a spreadsheet, especially if you plan to follow TR. People here experienced at looking at spreadsheets will pull out trends, conclusions, and solutions you'd never have even thought possible...and that's easiest if it's in our standard format.

Feeding - 2x a day is old school. Forget that. Multiple smaller.meals is easier on the pancreas, I don't think a single person here who's been at this awhile feeds twice a day. We just try not to feed after nadir, as the insulin is wearing off.

Meters - you'll drive yourself nuts worrying about "accuracy". Fact is, they're all allowed 20% variance. We care more about trends than actual numbers, and when you get into the lower numbers where it matters, the variance isn't a huge deal. Right now, high is high. Honestly, I'd just pick the cheapest meter with the cheapest strips, but do pay attention to blood drop size required. Something 0.3-0.5uL is good. Larger than that and you'll feel like a vampire every time you test.

Remission - while it is possible, and TR provides the best chance at it, never a guarantee. I will be honest - for a dose of 3U to have these numbers, you'd probably be in it for the long haul, remission a months/year(s) sort of thing if it's in the cards. To get into remission the pancreas needs to heal, and to do that it needs to spend as much time in the 50-99 range as possible. And we can't force a pancreas to heal! Has its own ideas about things.

TR is a real commitment. It's entire goal is that 50-99 range, the downside to that is that runs you right against hypoglycemic numbers. So, the solution is testing. Testing will keep him safe. TR needs 4 tests per day minimum. At minimum a preshot test before each shot to make sure it is safe to shoot, and one other test each cycle. Dose adjustments are done based on how low the BG goes, so we have to know that (or be able to reasonably infer it) before considering changes. We recommend moving those around throughout a few days - a +2 here (2 hrs after shot), a +7 there, a +3, etc. So that over a few days you have a rough outline of the whole cycle. Only the preshots tests need to be fasting for 2 hours (so no food 2 hrs before shot). Other than that, feed the cat how you will. We'll worry about tweaking feeding times later, need data first.

You can always switch methods/protocols if you find it isn't working for you.

As far as questions for the vet "can you just let me do my thing and stay out of the way? You can have a link to my spreadsheet" HA! Most of the experienced members here have that arrangement, my vet has a link to my sheet. He just writes the scripts, and knows I will call if I have any questions. I would just ask the vet the same things you asked here, and see what he/she says.

 

[Jamie & Clover]

Thanks so much! This is very helpful and I’m slowly beginning to get it. Still a bit unclear about testing and numbers, but I’l get it.
The vet today was not very knowledgeable about diabetes and admitted it, and I appreciated that. She did agree to write me scripts and do whatever I need. Seems like she was glad to not have to deal with it. I’m surprised that neither vet even knows about your site.
Sounds like I need to do the spreadsheet first. I work Tues-Fri. I’m pretty busy on those days so I may not get to it until the weekend.
Since the Libre expired I’ve been testing him with the glucose monitor and am getting the hang of it. I’m an acupuncturist and needle people all day, all over their bodies, and was surprised how hard it is to get the just right amount of blood. But now it’s taking only a couple pricks instead of 6 or 7! I’ve also been getting better glucose numbers in the last few days.

Now I’m checking him 4x day before each meal, except when he wakes me up at 5 or 6 am wanting to eat. I’d love to change that, but he’s always done that. And if it’s not him then my other cat Abbey wants to eat early. I don’t feed him again until 8:30 or 9am and his levels are the highest then. The rest of the meals are 4 hrs apart. Last couple of morning first readings have been 360 and 316 respectively. Then they slowly go down and by 9:00 pm they’re the lowest of the 4 readings at 81 yesterday and 96 tonight. These are great numbers compared to where he was. But this is where I’m unsure about what to do. I didn’t give him insulin last night or tonight with his last meal. So his reading this morning at 316 was pretty good considering he’d had no insulin the night before, Before he was in the 400’s by morning with 3u insulin the night before. Tonight I thought I’d check him 2 hrs after his 9pm feeding assuming it’ll be higher and I’ll give him 2units then. Can you please advise about this since this will be the routine until I can do the spreadsheet which again, may not be until the weekend.

I’ve never done acupuncture on my pets, haven’t really needed to, but will learn because I believe it could possibly help his pancreas heal. It’s too bad I can’t give him herbs. I’ll just be happy to get him regulated and adjusted to the routine.

Thank you again and would appreciate your letting me know what to do with these low numbers for his last meal/insulin injection.
Jamie

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
As you are really busy and can’t get a SS up and running until the weekend, I’m going to ask @Bandit's Mom if she wouldn’t mind setting one up for you.
She will send you a PM so keep an eye out for it. She will need some information from you.

That is good the vet is willing to write you scripts. Hopefully she will learn about FD from you.
If you are finding the BG is 81 or 96 at the end of the cycle, the amount of insulin you are giving could be too much OR Clover could have been bouncing and coming off the bounce. They can drop lower are the end of the cycle when they are coming off the bounce sometime. The best thing would be to get that SS up and running so we can see what is happening. Hopefully Bhooma (bandits Mom) will be along soon. Then if you can add the data you have already we will be able to see what’s going on. It’s much easier to see on a chart than just random numbers in a conversation ….if that makes sense.

I’m not sure if I am understanding you properly…..are you saying that the preshot BG tonight is 96 so you fed and now you are going to test 2 hours later to see if it is high enough to give a dose?is that what you are saying.
What is better to do if you get a lower than normal preshot BG is to stall, dont feed and test again in 20 minutes to see if the BG is rising. And post and ask for help. You will need to change the subject line to indicate you need help.
When you are just starting out we suggest you don’t give a dose of insulin if the Preshot BG is under 200, until you have more data telling us how Clover reacts to insulin.
As long as he did not have any ketones at diagnosis it is OK to skip the dose. If you give it 2 hours later, you are going to be way off schedule and the BG will have been food influenced. Does that all make sense?

 

[Bandit's Mom]

Hello and welcome to FDMB!
I can help set up your spreadsheet and signature. Will send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page.